Factors influencing faculty job satisfaction: A quantitative study of private medical colleges in Karachi.

OBJECTIVE: To identify key factors influencing academic job satisfaction among faculty members of private medical colleges in an urban setting. METHODS: The cross-sectional, quantitative study was conducted from October to November 2021 at the Department of Community Health Sciences, Fazaia Ruth Pfau Medical College, Karachi, and comprised faculty members associated with 13 private medical colleges in Karachi. Data was collected using a 32-item questionnaire that was scored on a 5-point Likert scale. Key predictors of job satisfaction were identified and evaluated. Data was analysed using SPSS version 23. RESULTS: Of the 200 subjects surveyed, 106(52.7%) were males. The overall mean age was 29.4±5.2 years. There were 145(72.5%) respondents who were married, 106(53%) had employed spouses, 102(51%) were either professors or associate professors, and 93(46.5%) had professional experience of 1-5 years. Three principal factors were identified; career growth opportunities, working conditions and compensatory packages (p<0.001). The lowest mean satisfaction score was observed for compensatory packages (1.74±0.84), followed by working conditions (2.28±1.41) and career growth (2.38±1.39). CONCLUSIONS: Improving compensatory packages, working conditions and career growth opportunities were found to be crucial for enhancing job satisfaction among faculty members in Karachi-based private medical colleges.

Exploring health seeking behaviour among incidentally diagnosed HIV cases in Rawalpindi, Pakistan: A qualitative perspective.

Objective: To identify the determinants of health-seeking behaviour among incidentally diagnosed cases of HIV and to explore the patterns of care seeking behaviour among these HIV infected persons. METHODS: The qualitative study based on the grounded theory was conducted from February to September 2019 at the Armed Forces Institute of Transfusion, Rawalpindi, Pakistan, and comprised incidentally diagnosed new cases of human immunodeficiency virus. Data was collected using in-depth interviews to understand how local environments and settings impact healthcare-seeking behaviour. Data was analysed using the constant comparison method. RESULTS: Of the 12 patients, 10(83.3%) were male, 1(8.3%) female and 1(8.3%) transgender. The mean age of the sample was 31±5 years. Of the total, 10(83.3%) patients were receiving free antiretroviral treatment from government hospitals in Rawalpindi/Islamabad, while 2 (16.7%) opted for some alternative form of healthcare. Ten (80%) were married and were carrying the diagnosis for >6 months. Processing of human immunodeficiency virus status, value placed in one's own health, experiences with healthcare provider and medication-related factors were the main themes that emerged from the data. Better counselling services, free-of-cost medication, positive patient-provider relationship and social support were the key players, while non-disclosure due to fear of stigma and beliefs about the disease were the main stumbling blocks. CONCLUSIONS: Value placed in one's own healthcare and thus the need for healthcare services, regardless of social norms, cultural reservations and personal beliefs, was the most important factor affecting the healthcare-seeking behaviour of human immunodeficiency virus patients.

Evaluation of empathy and fatigue among physicians and surgeons in tertiary care hospitals of Rawalpindi.

BACKGROUND AND OBJECTIVES: Clinicians need to build an astute doctor-patient relationship. The term clinical empathy is the ability of doctor to cognitively appreciate a patient's perspective, experiences, and deliver such an understanding back to patient. Studies associate high physician empathy with improved patient trust and clinical outcomes. In Pakistan, there is paucity of research data on this relationship. This study assessed the empathy and its relation to fatigue levels among physicians and surgeons. METHODS: This was a cross-sectional analytical study involving 262 Physicians and Surgeons (1:1) chosen by convenience sampling method. Physicians and Surgeons were included from three hospitals in Rawalpindi from September 2017 to February 2018 and RAO soft sample calculator was used. The Jefferson Scale for Physician empathy (JSPE) (score range 20-140) and Multidimensional Fatigue Inventory (MFI-20) (score range 20-100) were used as data collection tools. The data was analyzed using SPSS version 23. Statistical tests including T-test and Pearson Correlation were used. RESULTS: Overall, mean score of empathy was found to be 98.8±21.9 (range; 46-138). The empathy in Physicians (106.8±18.3) was found to be greater than Surgeons (89.4±22.1) and the difference was statistically significant (p value <0.01). Mean score of fatigue was 50.6±16.0. The fatigue level in Surgeons was greater than Physicians and the difference was found to be statistically significant (p value < 0.01). Strong negative correlation was observed between empathy and fatigue (r= -0.5, p=<0.01) using Pearson correlation. CONCLUSION: Overall, physicians had better empathy than surgeons, while fatigue scores were higher among surgeons. Fatigue is associated with empathy decay. This research provides an understanding of empathy deterioration and other factors responsible for it.

Role of serum leptin level as a marker of severity of pre eclampsia.

BACKGROUND: To explore the possibility of serum leptin being a marker of severity of pre-eclampsia, so that risk of imminent eclampsia and eclampsia can be reduced. METHODS: This observational study was conducted at a private hospital of Hyderabad from 31st July to 1st December 2007. Forty primipara with same age, body mass indices and gestational age were included in this study. Twenty women had raised blood pressure in third trimester of pregnancy and 20 women with a normal blood pressure in third trimester of pregnancy. The exclusion criteria included history of diabetes, twin pregnancy, chronic hypertension, liver or renal disease. After counselling and affordability of laboratory testing their blood sample was taken for serum leptin, uric acid, serum creatinine and urine for albumin. The serum leptin level was measured by radio-immunoassay (RIA) kits. All data was filled in a pre-designed proforma after taking detailed history and examination. Statistical analysis was performed on SPSS. Student's t-test was applied where applicable. RESULTS: Mean systolic and diastolic blood pressure between pre-eclamptic and control group showed a marked difference (p < 0.001) ranging from 149.50 +/- 3.44 and 104.40 +/- 3.03 as compared to control 107 +/- 1.56 and 74.50 +/- 1.49 respectively, similarly proteinuria was present in 20 (100%) cases of pre-eclampsia and 07 (35%) of normotensive women. Mean serum leptin level was significantly high in pre-eclampstic (79.380 +/- 3.287), when compared with a control group (27.825 +/- 1.050). Mean serum uric acid in pre-eclamptic (5.040 +/- 0.147) showed significant changes than control (3.600 +/- 0.141), while serum creatinine level was insignificant in both groups. It has been observed that Mean +/- SEM value of serum leptin level was much higher in severe pre-eclamptics (76.418 +/- 5.056) than in women with mild pre-eclampsia (40.856 +/- 2.807). All the parameters correlated positively and significantly with increased blood pressure. CONCLUSION: Elevated plasma leptin concentration appears to be a marker of pre-eclampsia independently or along with other parameters of pre-eclampsia could be used to reduce the severity of pre-eclampsia thus avoiding risk effects of pre-eclampsia to mother and foetus. This study still needs more research work to prove our results.

Frequency of second stage intervention and its outcome in relation with instrumental vaginal delivery versus caesarean section.

BACKGROUND: To determine the frequency of second stage intervention and the risk of maternal and foetal morbidity and mortality associated with instrumental vaginal deliveries versus caesarean section in our tertiary care set up. METHODS: This descriptive study was conducted in the Department of Obstetrics and Gynaecology (Unit-II) Liaquat University Hospital Hyderabad Sindh, Pakistan from January 2005 to December 2006. All the women who underwent instrumental vaginal delivery and caesarean section due to prolonged second stage of labour were included in this study. Data were collected on a pre-designed proforma, which included demographic details, maternal and perinatal morbidity as well as any complications etc. Finally, data were analysed through software program SPSS 10.0. RESULTS: Frequency of second stage intervention was 22.2%. Among, 400 women who undergone second stage intervention, 240 (60%) were delivered by caesarean section and 160 (40%) were delivered with the help of instruments. Majority of women, i.e., 49.25% were between 21-30 years of age, 73% were un-booked cases while 45% cases were primigravida. Complications with abdominal delivery were paralytic ileus in 35 (14.58%) cases, post partum haemorrhage in 30 (12.5%) cases and tear extension in 13 cases. Complications with instrumental delivery were vaginal tear in 28 (17.5%) cases, cervical tear in 12 (7.5%) and third degree perineal tear in 4 (2.5%) cases. The perinatal outcome with abdominal delivery (86.66%) was better as compared to instrumental delivery (72.5%). CONCLUSION: The frequency of second stage intervention seems high in our set up and is associated with significant maternal and perinatal morbidity. Maternal morbidity was more frequent abdominal delivery while neonatal morbidity and mortality was more frequent with instrumental delivery.

Clinical spectrum and management of ovarian tumours in young girls up to 20 years of age.

BACKGROUND: Ovarian tumours are one of the common malignancies all over the world affecting all age groups. This study analyses different clinical presentation and management of ovarian tumours in young girls up to 20 years. METHODS: Patients up to 20 years of age admitted with the diagnosis of ovarian tumour were included. Data collected on a proforma. Variables studied included age, presenting symptoms, investigations, surgical findings, type of surgery, histopathology reports and follow-up. The patients with malignant ovarian tumour were followed by oncologist as well as gynaecologist. Data analysis was done on SPSS. RESULTS: The mean age was 17.27 +/- 2.46 SD years. The common symptoms included abdominal mass, abdominal pain, urinary problems, menstrual irregularities and generalized malaise. All patients were operated after preliminary investigations. Patients were advised to have follow-up post-operatively after 1 month. The follow up was done by oncologist and gynaecologist. Six patients (12.5%) died and 22 (45.83%) were lost to follow up. CONCLUSION: Ovarian tumours are quite common in young girls. Majority of patients seek medical advice once the disease becomes symptomatic, complicated or advanced disease in the case of malignancy. Histopathology of the tumours revealed that epithelial cell tumour is the commonest tumour in contrast to germ cell tumour as reported by world literature.

Gestational trophoblastic disease: experience at a tertiary care hospital of Sindh.

OBJECTIVE: To determine the frequency, clinical presentation and management outcomes of Gestational Trophoblastic Disease (GTD). STUDY DESIGN: Descriptive case series. PLACE AND DURATION: Department of Gynaecology and Obstetrics, Liaquat University of Medical and Health Sciences, Jamshoro, from March 2003 to March 2004. PATIENTS AND METHODS: The case records of all the gestational trophoblastic cases during study period were analyzed regarding their illness history, clinical examination, investigations, treatment and follow-up. The main outcomes were measured in terms of duration, antecedent pregnancy, investigations, treatment and the follow-up. RESULTS: There were a total of 1030 obstetric admissions during the study period, which included 23 cases of trophoblastic disease. Hence, frequency of GTD was 1 per 45 live births. Of these 23 cases, 19 (82.6%) patients had hydatidiform mole and 4 patients had malignant trophoblastic disease. Eight patients (34.7%) received chemotherapy while rest of the patients had suction evacuation and follow-up. Among all patients, 21 (91.3%) fully recovered and 2 (8.69%) died because of extensive disease; metastasis extending upto brain. CONCLUSION: Frequency of trophoblastic disease was high in this series compared to world and national literature. Therefore, emphasis should be on the early diagnosis of disease as proper management in the early stages strongly influences the outcome of disease. Suction evacuation and follow-up are ideal treatments for benign trophoblastic disease.

Pattern of fetal deaths at a university hospital of Sindh.

BACKGROUND: Perinatal mortality is a significant public health problem throughout the world. Its prevalence is quite high in the developing countries on account of number of factors. Most of the causes are treatable and fetal outcome can be improved by provision of good health care facilities during antepartum and intrapartum periods and through public education regarding reproductive health and better utilization of health services. OBJECTIVE: To determine the pattern of intrauterine fetal deaths before or in the process of labor in our tertiary care set up. METHODS: This descriptive case series was conducted at Department of Obstetrics and Gynaecology (unit-IV) at Liaquat University Hospital, Jamshoro, Sindh,from April 2002 to October 2003. In total, 50 intrauterine fetal deaths from 24 weeks of gestation to full term pregnancy were analyzed. The case records of all the women were evaluated and data collected regarding their age, period of gestation, clinical features, antenatal records, previous obstetrical history, labor, mode of delivery as well as complications during or after the labor. RESULTS: Out of 697 deliveries, 50 (7.17%) babies were still born. Of these 84% were fresh still born. The commonest factors were antepartum hemorrhage (30%), mismanaged labor (26%), premature rupture of membranes (26%) and congenital anomalies (16%). CONCLUSION: Majority of fetal deaths in our set up are due to avoidable factors. Hence, there is strong need to improve the quality of care by proper antenatal care, identification of high risk cases and referral to tertiary care hospitals for proper management to prevent morbidity and mortality in this regard.

Meigs' syndrome.

Meigs' syndrome is a rare clinical condition commonly considered to be associated with malignant ovarian tumour. A case of unmarried female is presented who came with a slowly increasing abdominal mass. Clinical and ultrasonic investigations revealed a mobile, solid right adenexal tumour in the lower abdomen, along with ascites and pleural effusion of the right lung. The level of CA 125 was also raised. Diagnosis of Meigs' syndrome was confirmed after surgical intervention. The tumour was successfully removed and pleural effusion disappeared 15 days after the intervention. Cytomorphologic study of both the tumour and ascitic fluid was negative for malignancy.

Knowledge and attitudes regarding AIDS among female commercial sex workers at Hyderabad City, Pakistan.

OBJECTIVE: To determine the level of knowledge and attitudes regarding AIDS among female commercial sex workers (FCSWs) in Hyderabad City, Sindh, Pakistan. DESIGN: A cross-sectional survey. PLACE AND DURATION OF STUDY: Red light area of Hyderabad City, Sindh, Pakistan, from March to July 2004. SUBJECTS AND METHODS: A pre-designed questionnaire was administered to see the level of knowledge and attitudes regarding AIDs among FCSWs. In this regard, a total of 61 FCSWs were interviewed after getting informed consent. RESULTS: Mean age of the FCSWs was 27 years. Majority was uneducated and unmarried. All respondents had heard the word AIDS but no one knew about the word HIV as well as its meaning. All respondents believed that AIDS is a preventable disease and they knew some method of prevention. Television was most common source of knowledge. FCSWs had inadequate knowledge in terms of signs and symptoms and the treatment of disease. CONCLUSION: FCSWs of the Hyderabad city had insufficient knowledge and various misconceptions regarding AIDS. Therefore, there is a need for their education and improvement in socioeconomic status. There is also the need of further studies with substantial statistical work to generate more accurate data in this regard.

Low grade sarcoma of scrotal wall.

We report a rare case of low grade sarcoma of scrotal wall. A male child aged 2 1/2 years presented with history of scrotal lymphoedema involving the left side of scrotum, slowly progressive since birth. We planned scrotectomy but the patient was lost to follow-up. During intervening period, left inguinal omentopexy was done elsewhere. The patient again presented 3 years later with multiple swellings in scrotum. We performed almost complete scrotectomy with reconstruction of the scrotal defect using scrotal remnant as a stretchable musculocutaneous flap. A third of the residual scrotum could be expanded to resurface the entire scrotum. On histopathology, low grade malignant peripheral nerve sheath tumor of grade-I was confirmed. Post-operative follow-up showed no residual disease.

Primary tuberculosis of tongue.

A case of a 55 years old lady with tuberculosis of the tongue is reported. Patient presented with non-healing ulcer in dorsum of the tongue for one year. Initial biopsy and histopathological examination revealed non-specific inflammation. After surgery, biopsy report proved primary tuberculosis of tongue. Anti-tubercular therapy for nine months showed uneventful recovery of the patient.